一位初次診斷糖尿病併左下肢慢性潰瘍病患面臨截肢之護理經驗

Nursing Experience with a Patient of Newly Diagnosis Diabetes and with Chronic Ulcer of Left Lower Extremity Under Facing Amputation

本文描述一位個案初次診斷糖尿病併左下肢慢性潰瘍面臨截肢之護理經驗，因無法接受自己患有糖尿病，而未積極控制，導致左下肢傷口癒合狀況不佳，經醫師診斷為糖尿病併左下肢慢性潰瘍，須接受截肢治療，為徵詢第二治療建議，而轉診至本院，經雙下肢清創手術後，見傷口感染情形未見改善且癒合差，故於6月5日行第一次行截肢手術，及後續經清創與死骨切除手術治療，住院期間病情穩定控制，出院返家後由門診持續追蹤。因傷口治療不如預期，個案於短時間內，就須面對截肢威脅，過程中面對身體功能受損及心理衝擊，引發筆者動機。照護期間自2020年5月30日至6月11日，運用直接護理、觀察會談、傾聽、病歷查閱等方式收集資料，依據Gordon十一項功能性健康型態評估個案，確立個案有知識缺失、身體心像紊亂及急性疼痛之護理問題。筆者照護期間主動關懷病人及家屬建立良好互信關係，提供個別性護理措施，搭配藥物治療來緩解疼痛；引導家屬共同參與疾病認識及照護活動，藉由家屬的鼓勵與信仰支持，幫助個案接受疾病及身體結構功能的改變，更快適應截肢後生活，重拾自信；教導換藥技巧及輔助工具使用，以促進恢復日常生活功能，回歸社會。建議照顧糖尿病個案時，可及早加入遠距照護系統，以利監測後續居家自我照顧追蹤;並增進臨床護理人員術後復健訓練知識和技能，確實執行復健照護，使個案盡早恢復功能，提升照護品質。

This article describes the nursing experience of a patient who was diagnosed with diabetes for the first time and had chronic ulcers on the left extremity leg and faced amputation.Because of refusal to accept having diabetes, and not actively controlled, As a result of poor wound healing on the left extremity leg, the doctor diagnosed as diabetes and chronic ulcer of the left extremity leg, which required amputation treatment. In order to seek second treatment advice, the patient was referred to our hospital. After debridement of both lower extremities, the wound infection and poor healing, the first amputation operation was on June 5, followed by debridement and sequestrectomy, and finally was able to return home and keep follow up. Because the wound treatment was not as good as expected, the case faced the threat of amputation within a few months. In the process, he faced physical damage and psychological shock, which triggered the author's motivation. Care period from 30 May to 11 June 2020,Data were collected by means of direct nursing, observation and interviews, listening, and medical record review. According to Gordon's eleven functional health assessment cases, it was established that the cases included: (1) lack of knowledge; (2) physical and mental image disorders; (3) acute Pain care issues. Establish mutual trust through active care, provide individual nursing measures, and cooperate with drug use to relieve pain; guide family members to participate in disease awareness and care activities, and help patients accept disease and changes in body structure and function through family members’encouragement and belief support, to adapt to life after amputation faster and regain self-confidence; guide dressing change skills and the use of auxiliary tools to promote the recovery of daily life functions and return to society. This article recommends that when taking care of diabetic patients, they can join the remote care system as soon as possible to facilitate follow-up self-care and tracking at home; ward nurses can improve their knowledge and skills of postoperative rehabilitation training, and actually perform rehabilitation care, so that patients can recover their functions as soon as possible.